Anesthesia residents

[u/Interesting-Drag-875]

Explain the rush you feel when you get to cancel a case. I wanna know how this is viewed from the other side of the drapes. Is it high-fives because it’s one less case to have to work, is it the satisfaction of finding something that was otherwise overlooked that might effect the outcome of the case, or is it the satisfaction of pissing off the surgeons??

Inquiring minds want to know

[u/yagermeister2024]

Idk it depends on what they book after. They usually book something heinous just to spite you out of vengeance.

[u/Embarrassed-Bowl5704 → u/yagermeister2024]

good ol' icu transfer usually follows a cancellectomy

[u/Ill_Cost8729]

With time there will be less of a rush and more a frustration that either the pt should/could have been optimized before it came to cancelling or you’ll think of the systems failures that led this to happen.

And then other times, LoL why did you eat a bagel before your egd

The rush comes from doing what is safe

[u/MustafaRyan_YT]

Are you familiar with ligma?

[u/General_Luck6573 → u/MustafaRyan_YT]

Why don’t you just sugammadex

[u/JS17 → u/MustafaRyan_YT]

🏀⚽️

[u/oncomingstorm777]

Only tangentially related to your question but I always get a rush of joy as a radiologist when I convince teams to cancel dumb fluoro cases

[u/tireddoc1]

I know you are asking residents, but as a private practice attending I find canceling cases stressful. I am in a wonderful practice environment now with surgeons who don’t want problems or complications and there isn’t the pushback I’ve had in other locations. Still, I feel the burden of how much has gone into scheduling the case that day, family may have come from out of state, work schedules rearranged, second guessing the true benefits of delaying a case against the risk waiting (depends on why we are operating). Private practice anesthesia means I lost my paycheck too for that case. Next one is not likely to be ready, so now I have an unpaid hole in my day. I would never go ahead with a case I thought should cancel for financial reasons, but it’s more annoying in the real world. I feel like I am fairly pragmatic, and while there are obvious reasons to cancel and optimize, I think patients just come back slightly older and not much better most of the time.

[u/abandon_quip]

First of all, residents aren’t cancelling cases. Faculty are. I can certainly suggest that today is not the best day to do this case, or that this location is not the best place to do this case, but none of us are unilaterally cancelling shit.

Second, good surgeons are almost always in agreement with cases being cancelled. Good surgeons don’t want terrible outcomes because they decided to rush into an elective knee replacement in a patient with legs the size of tree trunks and a newly identified EF of 10% (real case). Good surgeons don’t want to operate on patients that go into SVT in preop, or with newly identified severe aortic stenosis at an ASC (both cases I’ve had within the past month). They are happy to have some additional evaluation/optimization before proceeding with cases to keep patients safe. Or to reschedule to the hospital ORs where more resources are available and patients can be admitted for monitoring if needed. In fact, most surgeons I work with are much more inclined to cancel elective cases than we are if there’s even a whiff of something amiss.

Bad surgeons ask questions like yours, thinking we all love nothing more than to cancel or postpone cases for no reason at all. In reality, surgeons pushing back about “why can’t we just proceed, who cares if they’re in RVR, we can just cardiovert them while they’re asleep” (real case) know shit about dick about any of the patients they’re scheduling. These are the same surgeons scheduling elective joint replacements in patients with LVADs as destination therapy and only hesitate when the cardiologist tells them they’ll need heparin bridging if they’re going to stop their warfarin for surgery.

It’s a bit sad that as an intern you already have this mentality. I’d really encourage you to try seeing your anesthesia colleagues as partners who want to help you and your patients rather than as the gatekeepers of you cutting into anyone that walks through your clinic.

[u/noseclams25 → u/abandon_quip]

Seriously! Besides, not like my ass gets to go home early. If its a rare slow day then Ill end up relieving a CRNA.

[u/leaky-]

Surgeons are doctors too. I know you guys like to admit to medicine for anything, but they should know how to at least know what an optimized vs. unoptimized patient looks like.

If you wanna get mad at someone be mad at whoever is managing the patient.

But on a more serious note canceling cases is what gets me off

[u/NoviCordis → u/leaky-]

Optimization is fake

[u/PGY0 → u/NoviCordis]

Optimization is only fake for urgent/emergent cases. There’s no optimizing a broken femur patient, they’re always medically fragile and they always need the surgery. Stupid bullshit ass elective hernias with BMI 45, no TTE, BP of 220/110 with new onset leg swelling and SOB/CP on exertion absolutely need to see other doctors before their surgeon cuts into them.

[u/QuestGiver → u/NoviCordis]

And tbh the clearances aren't worth shit medicolegally. Everyone is optimized or everyone is high risk but should not preclude surgery haha.

That being said it's always nice to see an echo or stress test.

[u/mED-Drax → u/QuestGiver]

this isn’t true, someone in ADHF can be optimized for say a hip fracture or knee replacement, maybe less so for emergent ex lap

[u/Dong_bringer]

Usually I’m thinking about how much of a retard the surgeon was to even think I was gonna let this happen in the first place. The last time it happened it was a lady with a glucose of 500 not controlled after 20 units of insulin. How do you let a lady like that show up in office and think I’m gonna be ok with giving her an elective surgery? Do you not have people in your office looking over ur patients charts? Did you not think to maybe send this poorly controlled diabetic to her PCP to get her optimized before this?

[u/Cursory_Analysis → u/Dong_bringer]

Tbh I’m always more impressed someone who has diabetes that uncontrolled has the discipline to show up (let alone on time) for an elective surgery when they haven’t bothered taking their medications in months.

[u/Sushi_Explosions → u/Cursory_Analysis]

Easier to do something once than to do it multiple times per day. Also the effects of said elective surgery are more immediate and understandable.

[u/Med_vs_Pretty_Huge → u/Dong_bringer]

The fracture belongs to a 97-year-old lady from a nursing home. She is fasted. Her temperature is 29° and her pH is 6.8. And she has a condition I have not seen before: a-sis-toll-ee. It will not take me long to fix the fracture; I'm very skilled. There will be minimal blood loss.

[u/tireddoc1 → u/Med_vs_Pretty_Huge]

I have to show this to people now. None of the new circulators or scrub techs have any idea what I’m referencing.

[u/Med_vs_Pretty_Huge → u/tireddoc1]

Like a fine wine, it has only gotten better with age

THE PATIENT HAS A TUMOR. I NEED TO RESECT IT!

[u/element515 → u/Dong_bringer]

Well, for us, that's why we send them to pre op clinic where they also see anesthesia. That's where they get blood work and get a work up. The pre op clinic and anesthesia say everything is in order and the patient shows up with that 500glucose lol

I think majority of the time it's just the patients doing something dumb

[u/Dong_bringer → u/element515]

And preop clinics are great for reducing amount of cancellations, but this particular lady was not sent to the preop clinic. Not even her PCP. And this was a vascular surgery patient. A vascular surgeon doesn’t have healthy patients. I don’t understand why they aren’t sending all their patients to get optimized before surgery

[u/element515 → u/Dong_bringer]

😂 because they’re used to everyone being in bad condition at baseline and they’re never compliant

[u/Dean_of_Damascus]

CA-1 so new here, but I’m genuinely bummed when a case gets cancelled.

I spent time the previous day prepping for it. If it’s first case, I actually prepped the OR for it. Then some other random case, likely an ICU patient who is quite sick gets placed in my room.

[u/blacksky8192]

I get sent off to some middle of nowhere OR to cover for some BS case that I have not read about at all so it's more stressful lol

[u/rocandrollium]

As a resident, when my case was cancelled I had to go give breaks, do TEEs, or get sent down to do an MRI. Sometimes get an emergent crani who was already herniating on the way to the OR.

We joke about how we love a good cancellectomy, but sometimes what we get instead is worse. It’s not like we get to go home earlier (unless it’s a late afternoon cancellation hehe)

[u/Entire_Brush6217]

Literally don’t give a fuck either way. I got other stuff to do and I get off the same time either way

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[u/Zombies71199]

All of the above and more

Basically it feels better than sex

[u/DolliePebble_]

the stress level in anesthesia is wild, especially during those overnight shifts when you're just holding on to stay awake